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General NPI Number Information
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NPI Number | 1316937568
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Entity Type | Individual
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Provider Name | CHARLES P HADDAD OD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 105 E MARKET ST
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City | SOMERVILLE
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State | TN
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Zip | 38068-1407
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Country | US
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Telephone | 901-465-3955
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Fax | 901-465-6797
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | SOMERVILLE
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State | TN
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Zip | 38068-0489
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Country | US
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Telephone | 901-465-3955
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Fax | 901-465-6797
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T377
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License Number State | TN
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